Dental Plans

Dental care is very important and plays a significant role in maintaining the overall health and well-being of a person. Every year you spent a good amount for maintaining a good dental health of yourself and your family. Organizations also take care of their employees’ health. Dental coverage or insurance will help you minimize the costs of dental care. Insurance companies including Delta Dental, Metlife, and Blue Cross and Blue Shield, to name a few, offer a variety of options tailored to each corporations needs. Though many companies pre-approve their own employees’ dental plans it is helpful to have a working knowledge of what your company’s plan can provide you. Dental plans are very beneficial as they help to manage your dental care expenses effectively and keep you smiling.

Insurance coverage and payment options

Most insurance companies offer the insured the option to pay their dentist in full and get reimbursement for the amount covered. Some dentists will require the patient to pay the full amount and get reimbursement by their insurance companies. It is advisable to ask the dentist if they require full payment or if they accept payment from insurance because some dentists will accept only the deductible and co-payment from the patient.

What if the office that I go to is “out of network” with my new plan? 

Some times your current office may not be on the list of pre approved practices for your dental plans. In such cases these offices still accept your particular type of insurance however the benefits may slightly be reduced. For example if you visit an “in network” provider and your yearly maximum for services is $2000 and which may be reduced to $1500 if you visit an “out of network” provider. Ever insurance company follows different policies and their plans may differ accordingly therefore it is recommended to check with your insurance company if you can see an “out of network” provider.

What is DMO or a DHMO?

A Dental Maintenance Organization (DMO) provides dental care from a network of dentists, generally emphasizes preventive services, and covers eligible services at 100% minus a specified co-payment, and does not require the completion of claim forms. An HMO only covers dental care services which are authorized in advance by an individual’s primary care dentist. These plans are similar to DMO or DHMO plans that are usually accepted by very large dental clinics or dental offices that just opened up.

What are the differences between a DMO and an indemnity dental plan?

A Dental Maintenance Organization (DMO) only provides care from a network of dentists which is authorized in advance by an individual’s primary care dentist. An indemnity dental plan enables participating members to receive care from any licensed dentist. Members are required to submit claim forms and the plan has deductibles and co-insurance.

There are many different types of dental plans offer by the dental insurance companies providing various dental benefits. Some of them are categorized below depending upon the common dental plan designs although the individual policies of each plan may differ.

Direct Reimbursement Programs: This program reimburses patients a percentage of the dollar amount spent on dental care, regardless of treatment category. This method typically does not exclude coverage based on the type of treatment needed and allows the patient to go to the dentist of their choice. Direct reimbursement dental plan eliminate the hidden cost of the traditional plans and is not specific to particular treatment or dentist. Direct reimbursement dental plan are affordable and have yearly maximum in addition to the benefit of selecting dentist In/Out of Network.

“Usual, Customary and Reasonable” (UCR) programs: This allows patients to go to the dentist of their choice. These plans pay a set percentage of the dentist’s fee or the plan administrator’s “reasonable” or “customary” fee limit, whichever is less. These limits are the result of a contract between the plan purchaser and the third-party payer. Although these limits are called “customary”, they may or may not accurately reflect the fees that area dentists charge. There is wide fluctuation and lack of government regulation on how a plan determines the “customary” fee level. Dental insurance companies use a “Usual, Customary and Reasonable” (UCR) fee guide according to which they customize the prices of every dental procedure they cover. When you visit the doctor, you will just have to pay a part of the dentist fees that the dentist charges and the difference is paid by the insurance company because the contracted dentist usually have an agreement with the insurance company.

Preferred Provider Organization (PPO): These are plans under which contracting dentists agree to discount their fees as a financial incentive for patients to select their practices. Dental Preferred Provider Organizations allow the member patients to receive dental care from a panel of doctors in the network at a lesser fee. The members covered under this plan should select only from the list of network providers to avail the maximum dental benefits.